The Incidence and Aetiology of Maxillofacial Trauma and Concomitant Traumatic Brain Injury in a Johannesburg Tertiary Hospital.

Abstract

Objective: To investigate the incidence and etiology of maxillofacial trauma (MFT) and its association with traumatic brain injury (TBI).

Background: Anecdotal evidence suggests that there is an association between MFT and TBI and that higher incidences of TBI are associated with frontal bone and mid-facial fractures. Despite the large volume of maxillofacial facial fractures treated in the authors' unit, no study has been undertaken to establish the relationship between TBI and maxillofacial fractures.

Methods: This was a retrospective single-center cross-sectional study that was conducted on patients who presented at Charlotte Maxeke Academic Hospital emergency department with MFT and concomitant TBI over a period of 1 year (January 2019-January 2020). The primary predictor was maxillofacial fractures, which were classified into upper, middle, and lower thirds. The primary outcome variable was TBI indicated by the Glasgow Coma Scale (GCS) and Marshall computed tomography (CT) classification (radiological finding in CT).Variables such as age, etiology, fracture type, and neurological injury indicated by the recorded GCS and Marshall CT classification (I-IV) were collected. Maxillofacial fractures were classified based on the anatomical location. The level of significance was set at P <0.05.

Results: A total of 112 patients (102 males, 10 females) presented with MFT and concomitant TBI. The age group 30 to 39, followed by 20 to 29 years, was most affected. Respectively assault (n = 67), gunshots (n = 16), and falls (n = 16) were the main causes of injury. Supra-orbital rim fractures ( P = 0.00193), frontal sinus fractures ( P < 0.001,), and panfacial fractures ( P < 0.001) were significantly associated with TBI. Severe TBI (GCS: 3-8) was associated with higher Marshall CT grading.

Conclusions: Facial fractures affecting the upper third and panfacial fractures pose a significant risk for TBI. To identify TBIs, a multidisciplinary evaluation of facial fractures is recommended, especially in high-risk groups.